| 腰长（3~4）mm封堵器治疗膜周部室间隔缺损出现术后心律失常的临床观察 |
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| 引用本文： | 和旭梅,谢学刚,何璐,王星烨,成革胜,杜亚娟,张玉顺.腰长（3~4）mm封堵器治疗膜周部室间隔缺损出现术后心律失常的临床观察[J].心脏杂志,2020,32(2):151-155. |
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| 作者姓名： | 和旭梅 谢学刚 何璐 王星烨 成革胜 杜亚娟 张玉顺 |
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| 作者单位： | 西安交通大学第一附属医院结构性心脏病科，陕西 西安 710061 |
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| 摘 要： | 目的 与腰长2 mm封堵器相比较，分析腰长（3~4）mm室缺封堵器介入治疗膜周部室间隔缺损（pmVSD）术后心律失常的变化。 方法 2008年6月～2014年12月在我中心确诊的450例pmVSD患者，术前超声心动图（TTE）等检查具有介入封堵指征。根据室间隔缺损左室造影形态、大小，结合术前TTE检查，个体化选用封堵器。术后监测ECG，复查TTE，观察治疗效果，统计心律失常的发生情况，进行比较分析。 结果 450例患者造影后均尝试封堵术。444例患者成功行介入封堵治疗，成功率99.2%。所有患者依据选用封堵器的不同，分为短腰组（腰长2 mm）和长腰组腰长（3~4）mm]。两组手术成功率无显著差异。术后新发心律失常149例，长腰组术后心律失常发生率显著低于短腰组（P<0.05）；其中，室上性心律失常和右束支传导阻滞短腰组发生率显著高于长腰组。短腰组出现3例III°AVB，1例Ⅰ°AVB，长腰组1例Ⅰ°AVB，无III°AVB发生。 结论 pmVSD介入封堵治疗安全有效，可作为具有适应证患者的首选治疗方法。长腰封堵器可使术后室上性心律失常和右束支传导阻滞的发生率更低。
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| 关 键 词： | 室间隔缺损 封堵器 介入治疗 |
| 收稿时间： | 2019-12-05 |
Clinical study of arrhythmia after transcatheter closure of perimembranous ventricular septal with (3~4)mm waist occluder |
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| Affiliation: | Department of Structural Heart Disease, First Affiliated Hospital, Xi’an Jiaotong University, Xi’an 710061, Shaanxi, China |
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| Abstract: | AIM To compare effects of a 2 mm waist-long occlude and analyze arrhythmia after transcatheter closure of perimembranous ventricular septal defect (pmVSD) with a 3~4 mm waist occluder. METHODS From June 2008 to December 2014, 450 cases of pmVSD patients were diagnosed at First Affiliated Hospital, and preoperative echocardiography (TTE) showed indications of interventional occlusion. According to the morphology and size of the left ventricular septal defect, and in combination with the preoperative TTE examination, an individualized occluder was selected. The ECG was monitored and TTE was reviewed after the operation to observe the therapeutic effect, and the occurrence of arrhythmia was counted for comparative analysis. RESULTS All 450 patients underwent occlusion after angiography, but 444 patients were successfully treated with a success rate of 99.2%. According to the difference in the use of occluders, all patients were divided into a short waist group (2 mm waist-long occluder used) and a long waist group (3~4)mm long occluder used]. There were no significant differences in the success rate between the two groups (P > 0.05). The incidence of postoperative arrhythmia in the long waist group was significantly lower than that in the short waist group (P < 0.05). The incidence of supraventricular arrhythmia and right bundle branch block in the short waist group was significantly higher than that in the long waist group. There were 3 cases of III °AVB 1 of Ⅰ° AVB in the short waist group. But in the long waist group there was only 1of Ⅰ° AVB. Conclusion The interventional therapy with the 3~4 mm waist pmVSD occluder appears to be safe and effective and can be used as the first choice for patients. The incidence of supraventricular arrhythmia and right bundle branch block after operation is lower. |
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